MEDICARE: SANDY L PARROTT DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1957410490	OTHER	MI	BCBS MED SURG PIN#

General Provider Information

NPI Number	:	1326341108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDY L PARROTT DDS PC

Provider Business Mailing Address
First Line	:	1017 HURON AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3770
Country	:	US
Telephone Number	:	810-984-3700
Fax Number	:	810-984-4313

Provider Business Practice Location Address
First Line	:	1017 HURON AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3770
Country	:	US
Telephone Number	:	810-984-3700
Fax Number	:	810-984-4313

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SANDY L PARROTT
Credential	:	D.D.S.
Telephone Number	:	810-984-3700

Provider Enumeration Date	:	12/16/2010
Last Update Date	:	12/16/2010

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